Abstract Background Metabolic syndrome (MetS) remains a major health problem worldwide and is strongly associated with an elevated risk of cardiovascular disease (CVD). MetS was proposed to identify more high-risk individuals and facilitate early intervention. Hyperuricemia has not been included in the current definition of MetS yet, despite its strong association with MetS. We aimed at exploring the prognostic value of adding hyperuricemia into the definition of MetS. Methods Data derived from NHANES (1999–2018) was analyzed. The old version of MetS (MetSold) is consistent to NCEP-ATP III criteria, while the new version of MetS (MetSnew) included hyperuricemia as the sixth criterion. Baseline characteristics were compared between participants with and without MetS, and outcomes were assessed by multivariate analyses. Results Of 36,363 participants analyzed, 12,594 (34.6%) and 14,137 (38.9%) met MetSold and MetSnew criteria respectively. Compared to MetSold, MetSnew identified additional 1534 participants with metabolic risk. Both MetSold and MetSnew were significantly associated with long-term all-cause and CVD mortality (all P < 0.001). Furthermore, the additional participants identified by MetSnew displayed the similar risk of all-cause and CVD mortality as participants met MetSold. MetSnew provided a better identification and reclassification ability (all-cause mortality: C-index improvement = 0.06, NRI = 0.03, IDI = 0.55; CVD mortality: C-index improvement = 0.02, NRI = 0.01, IDI = 0.61) when compared with MetSold. Conclusions The inclusion of hyperuricemia in the MetS criteria could identify a greater proportion of people at metabolic risk, thereby allowing for early intervention to prevent long-term adverse events.

The aim of this study was to investigating whether lncRNA H19 promotes myocardial fibrosis by suppressing the miR-29a-3p/miR-29b-3p-VEGFA/TGF-β axis. Patients with atrial fibrillation (AF) and healthy volunteers were included in the study, and their biochemical parameters were collected. In addition, pcDNA3.1-H19, si-H19, and miR-29a/b-3p mimic/inhibitor were transfected into cardiac fibroblasts (CFs), and proliferation of CFs was detected by MTT assay. Expression of H19 and miR-29a/b-3p were detected using real-time quantitative polymerase chain reaction, and expression of α-smooth muscle actin (α-SMA), collagen I, collagen II, matrix metalloproteinase-2 (MMP-2), and elastin were measured by western blot analysis. The dual luciferase reporter gene assay was carried out to detect the sponging relationship between H19 and miR-29a/b-3p in CFs. Compared with healthy volunteers, the level of plasma H19 was significantly elevated in patients with AF, while miR-29a-3p and miR-29b-3p were markedly depressed (P < 0.05). Serum expression of lncRNA H19 was negatively correlated with the expression of miR-29a-3p and miR-29b-3p among patients with AF (rs = -0.337, rs = -0.236). Moreover, up-regulation of H19 expression and down-regulation of miR-29a/b-3p expression facilitated proliferation and synthesis of extracellular matrix (ECM)-related proteins. SB431542 and si-VEGFA are able to reverse the promotion of miR-29a/b-3p on proliferation of CFs and ECM-related protein synthesis. The findings of the present study suggest that H19 promoted CF proliferation and collagen synthesis by suppressing the miR-29a-3p/miR-29b-3p-VEGFA/TGF-β axis, and provide support for a potential new direction for the treatment of AF.

多年的临床实践研究显示,老年重症心力衰竭患者不但存在严重的心脏损伤问题,与此同时其神经内分泌水平也在发生不同程度的变化[1].目前治疗临床上,药物治疗方式是老年重症患者的首选方法,一定程度上能够控制心力衰竭病情的进展,但不同药物之间的搭配非常重要,直接关系患者最终的疗效.在众多药物中,厄贝沙坦氢氯噻嗪是一种常用药物,但多年的应用实践发现该药物的单用效果不够突出,还需配合其他药物联合使用.为了探讨针对老年重症心力衰竭患者有效的联合用药方案,本研究以2018—2019年在我院接受治疗的150例老年重症心力衰竭患者作为研究对象,对比分析这些患者的资料与效果,汇报如下.

目的 针对临床上缺乏精确有效的心脏起搏器寿命的预测方法,提出基于起搏器电池的放电曲线特性,对起搏器电池耗竭时间进行预测.方法 建立锂电池消耗模型和动态预测机制,使用锂电池进行放电实验;同时,对未耗竭起搏器进行离体实验以及实验条件的探索.结果 放电测试实验表明预测效果良好,离体实验的可行性得到了验证.结论 基于起搏器电池放电特性曲线进行心脏起搏器寿命的预测具有可行性,在进一步的离体实验中支持下,可望建立精确的临床预测机制.

目的:分析SGLT2治疗冠心病合并2型糖尿病的临床效果.方法:选取我院收治的100例冠心病合并2型糖尿病患者作为研究对象,根据抽签法进行分组,将患者分为实验组(n=50)和对照组(n=50).对照组患者选择常规药物治疗,实验组选择常规药物加SGLT2(达格列净片)治疗,对比两组患者的血糖控制情况.结果:实验组患者的空腹血糖、餐后2小时血糖以及糖化血红蛋白水平均低于对照组,差异显著(P＜0.05).结论:SGLT2应用于冠心病合并2型糖尿病患者的治疗中临床疗效较佳,有较高的安全性,值得临床应用.

目的 探索D-二聚体在预测老年患者下肢深静脉血栓中的价值.方法 方便选取2015年1月—2018年4月在该院住院治疗的老年患者300例为对象,根据患者住院期间是否发生下肢深静脉血栓分组:DVT组共有80例,非DVT组220例,所有患者定期进行D-二聚体的检测.结果 DVT组患者的D-二聚体水平(3.98±0.43)mg/L高于非DVT组(1.45±0.21)mg/L,差异有统计学意义(t=67.910,P<0.05);D-二聚体对老年DVT的预测价值方面:当D-二聚体临界值为0.5 mg/L时,60～79岁患者的预测特异度高于≥80岁患者,差异有统计学意义(P<0.05),但敏感度差异无统计学意义(P>0.05);当临界值为1.0 mg/L时,60～79岁与≥80岁患者的预测敏感度、特异度差异无统计学意义(P>0.05);当临界值为2.0 mg/L和3.0 mg/L时,≥80岁患者的预测敏感度、特异度均高于60～79岁患者,差异有统计学意义(P<0.05).结论 D-二聚体在老年下肢深静脉血栓形成中具有较高的预测价值,其中年龄在60～79岁患者宜将D-二聚体临界值设为0.5 mg/L,≥80岁患者宜将D-二聚体临界值设为2.0 mg/L.

患者男性,55岁,因胸闷、心悸不适10年,加重1周入我院治疗.入院时心电图示窦性心律,可见部分频率为60～75次/分,P波消失,窄的畸形QRS波(88 ms),不完全左束支传导阻滞图形,缓慢起始,缓慢终止,与窦性心律交替出现,临床诊断为加速性室性自主心律(AIVR).动态心电图(Holter)检查显示室性早搏负荷为57％,经心脏超声、心肌酶学、冠状动脉造影、同位素心肌显像等检查排除器质性及继发性因素后决定行电生理检查.EnSite NAVX三维标测系统激动标测和起搏标测均提示AIVR起源于右室后侧壁,于此处标测到理想靶点(单极电图呈QS型且领先体表QRS波42 ms),行导管射频消融获得成功.术后患者症状改善,3个月后随访Holter未再出现AIVR.

目的 针对冠心病(慢性心肌缺血综合征)合并慢性肺源性心脏病病人临床诊治效果和诊治方法进行探究.方法 选2015年3月～2018年6月间我院收治的符合冠心病诊断标准且符合肺心病诊断标准的冠心病(慢性心肌缺血综合征)合并慢性肺源性心脏病病人112例作为研究对象,根据病人的具体情况对其进行综合治疗.在治疗周期结束之后,对这112例病人的临床治疗效果进行观察和分析.结果 死亡病人6例,死亡率5.36％;无效病人4例,治疗无效率3.57％;治疗有效病人共28例,治疗显效病人共74例,治疗有效率为91.07％.病人各项指标在治疗前后表现出来的差异具有统计学意义(P<0.05).结论 冠心病合并慢性肺源性心脏病是一种发病机制比较复杂的疾病,其体征和临床症状互相掩盖.在临床上,病人病情经常出现反复发作的情况,死亡率和漏诊率比较高,对病人的身体健康构成严重威胁.医护人员在诊断过程中要全面、深入了解病人病史,仔细观察病人的临床特征,避免出现漏诊情况.在对冠心病合并慢性肺源性心脏病进行治疗的时候,要全面兼顾到心脏病和冠心病的治疗,通过综合干预提高病人的临床诊治效果.

Objective To analyze the correlation between plasma level of homocysteine,of D-dimer and carotid intima-media thickness (cIMT) of patients with essential hypertension.Methods From April 2014 to April 2016,a total of 492 patients confirmed as essential hypertension was selected in the Department of Cardiology,Electric Power Hospital of Shanghai,and they were divided into A group (with normal cIMT,n =200),B group (with thickening of cIMT,n =223)and C group (with plaque formation,n =69) according to cIMT General information,FBG,blood lipids index,plasma levels of homocysteine and D-dimer were compared among the three groups,and correlation between plasma of homocysteine,of D-dimer and cIMT of patients with essential hypertension were analyzed,respectively.Results No statistically significant differences of gender,body mass,FBG,HDL-C or LDL-C was found among the three groups (P ＞0.05),while there were statistically significant differences of age,disease course,TC and TG (P ＜ 0.05).Plasma levels of homocysteine and D-dimer of B group and C group were statistically significantly higher than those of A group,meanwhile plasma levels of homocysteine and D-dimer of C group were statistically significantly higher than those of B group (P ＜ 0.05).Partial correlation analysis results showed that,plasma homocysteine level was positively correlated with cIMT after correction of age,disease course,TC,TG and plasma D-dimer level (r =0.58,P ＜ 0.05),meanwhile plasma D-dimer was positively correlated with cIMT after correction of age,disease course,TC,TG and plasma homocysteine level (r =0.29,P ＜ 0.05).Conclusion Elevation of plasma level of homocysteine,of D-dimer is positively correlated with the thickening of cIMT,respectively.

目的 探讨对冠心病患者使用阿托伐他汀、曲美他嗪进行联合治疗的临床效果.方法 选取2012年1月~2016年1月我院收治的冠心病患者510例,随机分成三组,A组170患者采用阿托伐他汀进行治疗,B组170例患者采用曲美他嗪进行治疗,C组170例患者采用两药联合治疗,观察三组的疗效.结果 经过四周的治疗,C组的治疗总有效率明显高于A、B两组(82.35%vs83.52%vs94.12%),差异具有统计学意义(P<0.05).结论 对冠心病患者行阿托伐他汀、曲美他嗪进行联合治疗的疗效显著,且安全有效,值得临床上加以推广.